SIR Today

“There is an unmet clinical need for effective treatment options in patients with liver-dominant metastatic leiomyosarcoma who have exhausted systemic therapies,” said Jonathan Henning, presenting author. “In most cases, progression of liver metastases is the life-limiting factor, making liver-directed therapy a rational therapeutic approach.”

However, there is no consensus within the interventional radiology community regarding the optimal liver-directed treatment for metastatic leiomyosarcoma, he said.

Conventional TACE (cTACE), radioembolization (TARE) and DEB-TACE are all used across institutions, with treatment selection largely dependent on operator preference rather than robust scientific evidence. According to Henning, a major reason for this lack of data is the rarity of the disease—which is what spurred researchers at the University of South Florida Morsani College of Medicine and the H. Lee Moffit Cancer Center to investigate further.

“As a high-volume tertiary cancer center, we had the opportunity to evaluate DEB-TACE in a relatively large cohort of patients,” Henning said.

Researchers reviewed medical records of patients with metastatic hepatic leiomyosarcoma who underwent doxorubicin DEB-TACE from December 2014 to September 2024 were retrospectively reviewed to evaluate radiographic response, survival and clinical and biochemical toxicities.

“We favor DEB-TACE over cTACE because cTACE is difficult to standardize across institutions,” Henning said. With cTACE, the droplet size and composition of the doxorubicin–lipiodol–iodinated contrast emulsion can vary substantially depending on component ratios, contrast chemistry and mixing technique, leading to operator-dependent variability. In contrast, Henning said, DEB-TACE offers a more standardized and reproducible treatment approach.

“We chose DEB-TACE over TARE for two main reasons: First, doxorubicin-loaded DEB-TACE has demonstrated efficacy in hepatocellular carcinoma, despite HCC being relatively insensitive to intravenously administered doxorubicin. In leiomyosarcoma, however, doxorubicin is a cornerstone of first-line systemic therapy, making high-concentration intra-arterial delivery via DEB-TACE particularly compelling.”

Second, he said, DEB-TACE has a favorable toxicity profile for normal liver parenchyma and can be safely repeated, whereas repeated whole-liver TARE is associated with an increased risk of radioembolization-induced liver disease and cirrhosis.

The study included 29 patients, 23 of which (79.3%) had bilobar and 6 (20.7%) who had unilobar disease, while 20 patients (69%) had extrahepatic metastases at the time of the first DEB-TACE. Twenty-five patients (86%) received multiple lines of systemic therapies before DEB-TACE.

“Our findings suggest that DEB-TACE is a safe and effective treatment option for patients with unresectable, liver-dominant metastatic leiomyosarcoma,” Henning said. “These results support a potential expanded role for liver-directed therapy in a patient population with otherwise limited therapeutic options and provide a foundation for future prospective studies.”

Prospective studies with larger patient cohorts are needed to confirm the clinical benefit of DEB-TACE in metastatic leiomyosarcoma, Henning said. Given the rarity of this disease, such studies will likely require multi-institutional collaboration.

“Our study represents the largest reported cohort of patients with hepatic metastatic leiomyosarcoma treated with DEB-TACE,” said Henning. “It demonstrates that this approach can provide meaningful control of liver disease with a favorable safety profile, even in heavily pretreated, chemotherapy-refractory patients.”